Massachusetts mess: Without cost control, promise of coverage is flimsy

The 2006 Massachusetts health care law newly covers many low-income people, but its promise of coverage for all is flimsy. It paid little attention to adequacy of coverage, and is not durably affordable.

Because the law ignored the rise in underlying medical costs, Massachusetts faces soaring premiums, eroding benefits, or unbearable demands for greater state subsidies in future years.

The law is under-financed. Business pays virtually nothing.

Already, state government lacks enough money to make new subsidized insurance affordable for all. Planned premiums and high out-of-pocket costs will leave many who are mandated to buy new coverage unable to afford needed care. Yet powerful hospitals won big rate hikes.

Massachusetts health spending per person is highest of any state. With about half of health spending wasted on unnecessary services, financial paperwork, excess prices, and theft, current spending could finance the care that works for all—but only if coverage for all is married to cost controls.

If reformers focus solely on putting insurance cards in Americans' pockets, many will remain exposed. Demanding high patient cost-sharing won't save money, but could kill.

Decades of failed cost controls ignored or marginalized doctors. To recycle wasted sums in order to finance solid coverage for all, we need a clinical, financial, legal, and political peace treaty with doctors. If relieved of paperwork and malpractice suits, doctors must be encouraged and obliged to carefully spend vast budgets to equitably care for all.